Browsing by Subject "Radiation Oncology"

Now showing 1 - 17 of 17
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    Advanced breast cancer: A retrospective review comparing two palliative radiotherapy protocols used at Groote Schuur Hospital between 2010 and 2013
    (2016) Fakie, Nazia; Simonds, Hannah M; Naiker, Thurandarie
    Purpose: To retrospectively evaluate and compare the loco-regional progression free survival (PFS), overall survival (OS) and acute effects of the two breast palliative regimes used in patients with locally advanced or metastatic breast cancer between 2010 and 2013 in a single institution. Methods: Compliance to treatment, acute skin reactions, progression free and overall survival were retrospectively evaluated in patients who received palliative breast radiotherapy for locally advanced breast cancer between 2010 and 2013. The radiotherapy regimes were either 4Gy per fraction for 5 fractions treated 4 times a week (20Gy) or 6Gy per fraction for 6 fractions treated once a week (36Gy). They may have received previous chemotherapy with minimal or no clinical response, as well as hormonal treatment. Results: Forty three patients were followed up over a median period of 24 months, 14 of which received 20Gy and 29 received 36Gy. The average age was 64 years old. Compliance was 88% in both groups. Both groups had either grade 1 (71% vs 62%), grade 2 (21% vs 24%) or grade 3 (8% vs 14%) acute skin reactions. No grade 4 skin reactions were documented. The PFS was shorter at 4.5 months in the 20Gy group compared to 7.7 months in the 36Gy group (p=0.27). The OS was also shorter at 25.8 months in the 20Gy group compared to 29.6 months in the 36Gy group (p=0.51) Conclusion: This study did not show a statistically significant difference in terms of PFS and OS between the two radiotherapy regimes. They both remain reasonable options in local palliation in patients with locally advanced breast cancer.
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    Clinical symptoms and volumetric radiological responses of acoustic neuroma patients, treated with hypo-fractionated image guided radiotherapy (IGRT) at Groote Schuur hospital between 2013 and 2016
    (2018) Riddick, Alison; Parkes, J; Burger, Hester
    Background: Stereotactic radiosurgery (SRS) is the gold standard for treatment of small and medium sized tumours, although fractionated regimens are well described. Access is limited in resource-constrained settings. There are no South African data describing outcomes of AN patients treated with fractionated stereotactic radiotherapy (SRT) using photons. We describe clinical and radiological outcomes of AN patients treated with SRT at an academic centre in Cape Town, South Africa. Objectives: To describe patient demographics, tumour characteristics and patients’ symptoms and changes in symptoms at follow-up. To investigate tumour local control (LC) rates at last follow up MRI, and compare LC rates described for SRS in the literature. To correlate radiologists’ serial 2D maximum linear diameter (MLD) measurements with calculated 3D tumour volume (TV). Methods: Fifteen AN patients treated with modified SRT (18.0gy/3fractions, were identified from the planning database; 13 were included. Patient data and tumour characteristics (size, laterality and previous surgery) were retrospectively extracted from clinic folders. Initial planning data was accessed and checked. Tumour volumes were contoured by the author on all subsequent MRI’s per patient and validated by a second investigator; tumour volume (TV) was automatically calculated. Radiologist’s 2D MLDs were compared with 3D TV. Sensitivity and specificity of radiologist reported change of MLD as a measure of actual change in TV was calculated. LC was calculated, from time of treatment to time of last MRI or time of progression (defined as ≥20% increase in TV). Results: Mean age was 60.4years (range 45-79years), with 4 (30.8%) being female. Seven patients (53.8%) had left sided tumours and median tumour size was 1.15cm3 (mean 1.59 cm3; range 0.62-3.35 cm3). Nine patients (69.2%) had Koos stage 2 ANs, 3 (23.1%) had stage 3 tumours and 1 (7.7%) had a stage I tumour. Two patients had NF2.Median follow-up time 12 was 29 months (range 0-50 months). Median baseline TV, as was 1.15 cm3 (mean 1.59cm3 with range 0.62-3.35 cm3). Three patients had no follow-up MRIs: 2 demised and 1 declined further follow-up. In total 5 patients died, 4 of unrelated causes and 1 of unknown cause (median time to death after RT 24 months, range 6 - 36 months). LC was 74% at 36months. Hearing preservation rate was 67%. No new facial or trigeminal nerve symptoms were noted. Radiologists correctly reported tumour growth in 100% of tumours that grew, and specificity was 77.3% in those that were stable. Conclusion: This is the first local study in hypofractionated SRT using photons. We show lower LC rates than seen in literature; our numbers are small and short follow up time short, with high attrition rates. Acute treatment toxicities were absent. Longer term follow-up is needed to assess late RT effects. A prospective study using this method of treatment would better define LC.
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    Continuous low dose rate irradiation of the rat brain
    (1999) Madhoo, Jitesh; Blekkenhorst, Gerhardus Hendrikus
    The reported median survival time for patients who are diagnosed with high grade astrocytomas and who undergo postoperative radiotherapy is of the order of 24 to 40 weeks. The course of radiotherapy administered to these patients takes up a considerable portion of their expected survival time. Therefore, any means of reducing the treatment time may contribute to an enhanced quality of life for these patients. A potentially useful method for the reduction of the treatment time may be achieved with the use of continuous low dose rate external beam radiotherapy, where the treatment is administered over a 12 to 24 hour period. A relationship between fractionated and continuous low dose rate irradiation has been reported for skin, however, no such relationship has been reported for the brain. Low dose rate protocols that are equivalent in effect to fractionated (conventional) protocols can be derived using the linear quadratic theory, provided that quantitative radiobiological data for normal tissue (brain) is known. Thus, the aim of the current study is to test the radiation tolerance of the rat brain to low dose rate and fractionated radiation in order to establish the values for the parameters of the linear quadratic model.
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    Determination of an optimal treatment margin for intracranial tumours treated with radiotherapy at Groote Schuur Hospital
    (2020) Vos, Andre; Naiker, Thuran; Mac Gregor, Hannelie
    Background Accurate delivery of radiotherapy is a paramount component of providing safe oncological care. Margins are applied when planning radiotherapy to account for subclinical tumour spread, physiological movement and set-up error. Set-up error is unique to each radiotherapy institution and should be calculated for each organ site to ensure safe delivery of treatment. Aim and setting The aim of this study is to calculate the random and systematic set-up error for a cohort of patients with intracranial tumours treated with 3D Conformal Radiotherapy at the Department of Radiation Oncology, Groote Schuur Hospital, South Africa. After obtaining above mentioned data the ideal CTV-PTV expansion margin was calculated using published CTV-PTV expansion margin recipes. Patients and methods The Electronic Portal Images (EPID) of 20 patients who met the inclusion criteria were compared to their Digitally Reconstructed Radiograph (DRR). The set-up error for each patient was measured after which the random (s) and systematic (S) set-up error for the study group could be calculated. With both these values known the CTV-PTV expansion margin could be determined. Results The largest error was in the Superior/Inferior (SI) direction, followed by the Medial/Lateral (ML) direction and least in the Anterior/Posterior (AP) direction with 87.7%, 76.2% and 91.6% of the errors in the ML, SI and AP directions respectively being less than 3mm. There was no error larger than 5mm in the ML or AP direction with 6.1% of the SI error larger than 5mm. The random and systematic error in all three directions for this patient cohort were less than 2mm conforming to acceptable standards of delivering safe radiotherapy. Using Stroom's margin recipe (2S + 0.7s) a CTV-PTV expansion margin of 5mm can safely be applied for this patient cohort. Conclusion When treating patients with intracranial tumours at Groote Schuur Hospital the CTV-PTV expansion margin can safely be reduced from 1cm to 5mm.
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    Dosimetric comparison of volumetric modulated arc therapy and three dimensional conformal radiotherapy in the adjuvant setting for the management of gastric cancer : target volume coverage and normal tissue sparing
    (2014) Reddy, Bhiskar; Robertson, Barbara
    Whilst the benefit of adjuvant radiotherapy in gastric cancer is known, the optimal means of delivery, including two dimensional conventional, three dimensional conformal radiotherapy, intensity modulated radiotherapy and volumetric modulated arc therapy is less certain. The purpose of this study is to assess and compare volumetric modulated arc therapy (VMAT) and three dimensional conformal radiotherapy (3DCRT) plans in adjuvant radiation of gastric cancer.
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    The effects of the modification of energy metabolism on cellular response to ionizing radiation
    (1997) Hunter, Alistair John; Blekkenhorst, Gerhardus Hendrikus
    It is generally accepted that energy is required for repair of radiation-induced damage in living cells. Some of this energy is probably provided by adenosine triphosphate (ATP), which is derived from energy substrates via energy metabolism. This dissertation follows two general avenues. The first explores the effect of radiation on ATP levels after irradiation of cells. The second investigates the effect of inhibitors of certain pathways associated with energy metabolism on radiation response. It was proposed that ATP levels might be raised after irradiation in some systems and that this rise in ATP might be due to compensatory mechanisms related to repair. Experiments were conducted using B16 melanoma cells in vitro and using normal murine liver and CaNT tumours in vivo. ATP concentration was measured in extracts of these cells after irradiation using the luciferase-luciferin method. No major changes from unirradiated controls were found. Several types of substrates exist from which cells can derive energy, including glucose and glutamine which are initially metabolised via glycolysis and glutaminolysis, respectively, before their products are further metabolised in respiration. Since energy is necessary for repair of radiation damage, it has been proposed that the inhibition of energy metabolism might alter the radiation response of cells. An inhibitor of glycolysis, 2-deoxyglucose (2DG), and an inhibitor of glutaminolysis, aminooxyacetic acid (AOA), were administered to CHO cells in vitro to determine the effects of these substances on cellular radiosensitivity and repair. Repair was assessed by means of a split radiation dose experiment. The design of such an experiment required that cells be exposed to inhibitory test media for different times between two fractions of radiation. Any changes in clonogenic survival with time between tween fractions could, therefore be as a result of repair effects or as a result of changes in radiosensitivity. A method of estimating and subtracting the effects of radiosensitivity to make conclusions concerning repair is presented and discussed. Most combinations of 2DG, AOA, glucose omission and glutamine omission in culture media resulted in reductions in repair rate but the extent of repair was found to vary from one medium variation to the next. In addition, the effects of various culture media on glycolysis/PPP (glycolysis/pentose phosphate pathway) and glutaminolysis were investigated by determining the production of CO2 and lactate from radiolabelled-glucose and -glutamine substrates. It was apparent that the presence of either of the inhibitors, 2DG or AOA, could inhibit the activity of glutaminolysis and reduce oxygen consumption. 2DG was shown to inhibit glycolysis/PPP but AOA was shown to stimulate glycolysis/PPP, suggesting a regulatory link between glutaminolysis and glycolysis/PPP. The presence of either inhibitor resulted in a reduction in the rate of radiation damage repair. The medium which had the most significant effect in respect of repair inhibition and increased radiosensitivity was medium lacking both glucose and glutamine and containing both 2DG and AOA. This medium was shown to inhibit oxygen consumption and to result in a depression of both cellular glycolysis/PPP and glutaminolysis. The effect of 2DG on the rate of growth and radiation induced growth delay of three murine tumours in vivo was assessed. 2DG alone inhibited the growth of B16 tumours. However, 2DG alone produced little if any change in the rates of growth of Fib/T tumours and rhabdomyosarcomas but the combination of 2DG and AOA produced an inhibition of growth in the Fib/T tumour. 2DG appeared to enhance the effects of radiation in the Fib/T and B16 tumours but not in the rhabdomyosarcoma, although, in the Fib/T, the combination of AOA, 2DG and radiation was less effective in inhibiting tumour growth than was radiation alone. The effects of radiation and 2DG did not appear to be additive in the Fib/T tumour and the B16 tumours which may imply an influence of 2DG on repair or radiosensitivity. This work suggests that the effects of radiation can be altered by manipulation of metabolic pathways associated with the supply of energy. However, a complex interaction of pathways is probably also involved and it is the detail of this interaction which may partially determine the severity of radiation response.
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    Ependymal tumours in childhood: outcomes and prognostic factors
    (2017) Nkosi, Zanele; Parkes, Jeannette; Hunter, Alistair
    OBJECTIVES: To retrospectively review the patient demographics, disease profile and treatment outcomes of paediatric patients treated for ependymoma at our institution. STUDY DESIGN AND METHODS: 51 eligible patients were treated between 1980 and 2013. The median age at presentation was 6 years. The majority of patients were male (66,7%), had infratentorial tumours (62,7%) and had low-grade tumours (70,6%). Gross total resection (GTR) was achieved in 22 patients (43,1%). Thirtyeight patients received adjuvant radiotherapy (76,5%) and 10 (19,6%) received adjuvant chemotherapy. RESULTS: The 5-year overall survival (OS) was 63,3 % (median follow up of 46 months). The 5 year progression free survival (PFS) was 50,70%. Seventeen (33,3%) patients experienced treatment failure, of which 13 (76,5%) represented local failure. The median time to first relapse was 20 months. The 5 year PFS for children > 3 was 50,0 % and 27,7% for children ≤ 3 years of age (p = 0.0356). GTR had a superior 5- year OS of 73,9% over subtotal resection with a value of 56,7% (p = 0.0016). Similarly an improved 5-year PFS of 70,3% versus 29,1% was observed with GTR over subtotal resection (p = <0.0001). Patients who received adjuvant radiotherapy (RT) had significantly better outcomes than those in whom RT was not given (p = <0.0001, 5 year OS of 69,7% versus 37,5%). CONCLUSION: This review confirms the finding that GTR is associated with improved outcomes and that adjuvant radiation therapy positively impacts survival. The worse outcomes in the younger age group requires further evaluation and possible change in treatment protocol for this group of patients.
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    Evaluation of target motion and determination optional treatment margins for prostate cancer treated with external beam radiotherapy on Halcyon
    (2023) Algar, Marion; Punt, Lydia
    Background External beam radiotherapy (EBRT) is an important part of the treatment for prostate cancer. To account for organ motion and set-up error, margins are used in radiotherapy planning. These are essential for the delivery of safe and effective treatment. Aim and Setting To measure prostate motion during the course of EBRT on the HalcyonTM at Groote Schuur Hospital. Using published margin recipes, the minimum clinical target volume (CTV)-planning target volume (PTV) expansion margin was calculated. Patients and Methods Prostate motion was evaluated by comparing prostate position on the planning CT to cone-beam CT (CBCT) scans. Prostate position error in the medio-lateral (ML), antero-posterior (AP) and superoinferior (SI) directions was measured for each CBCT. The systematic (Σ) and random (σ) error of prostate motion was calculated. The minimum CTV-PTV margin was determined. Results The mean position error of the prostate was -0.04mm (95% CI -0.14, 0.10), -0.30mm (95% CI -0.70, 0.15) and -0.40mm (95% CI -0.89, 0.00) in the ML, AP and SI directions, respectively. Using Van Herk's margin formula (2.5Σ +0.7σ), the following minimum CTV-PTV margins for the ML, AP and SI directions were calculated: 1.9mm, 6.9mm and 7.8mm, respectively. Using Stroom's margin formula (2Σ +0.7σ), the following minimum CTV-PTV margins for the ML, AP and SI directions were calculated: 1.6mm, 5.8mm and 6.6mm, respectively. Conclusion Based on prostate motion, our institution's current margins are sufficient. However, further studies are necessary to measure other factors that influence the CTV-PTV margin before considering reducing this margin.
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    The influence of cisplatin dose variations during concurrent weekly chemo-radiation in stage IIB cervical cancer at Groote Schuur Hospital
    (2017) Jemu, Mtabeni; van Wijk, Leon
    Objective: To examine the effect of treatment and tumour factors on the overall survival (OS) of patients completing chemo-radiation (CRT) for stage IIB cervical cancer. Materials and methods: Retrospective audit of 228 patients with stage IIB cervical cancer treated between 1995 and 2010, who received CRT with at least 45 Gy external beam radiation, two to four brachytherapy insertions, and one or more cycles of concurrent weekly cisplatin (40mg/m², capped at 60 mg/week). Results: Mean tumour size was 5.5cm, bilateral parametrial involvement in 40% of patients, lateral parametrial involvement in 50%, and vaginal spread in 43%. Mean total dose to Point A was 83 Gy (range 61-96) linear quadratic equivalent dose to 2 Gy/fraction. Mean overall treatment time (OTT) was 45 days. The average weekly haemoglobin (AWHB) during treatment was 11.6 g/dL (range 8.8-15.5). Blood transfusions before or during chemo-radiation were given in 33% of patients. Two thirds of patients completed five or six cycles of weekly cisplatin. Reasons for fewer than five cycles were: scheduling failure, neutropaenia, and/or renal impairment. No outcome differences were observed for Monday vs. Thursday cisplatin administration. The 5-year OS was 60%. Patients completing fewer than six cycles had a worse OS (55 vs. 76%, p=0.02). By multiple regression analysis for OS, only six cycles of cisplatin, squamous histology, and AWHB>10g/dL were significant. Conclusions: Maintaining HB>10 and administering six cycles of weekly cisplatin at the dose regimen used appear to be requirements for maximal benefit during CRT of stage IIB cervical cancer.
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    A retrospective review of outcomes in patients with node-negative stage IB cervical cancer treated with adjuvant standard pelvic field radiation versus small field pelvic field radiation
    (2017) Ralefala, Tlotlo; Van Wijk, Leon
    Objective: A retrospective review was conducted to ascertain whether there are differences in outcome or complications between node-negative patients with stage IB cervical cancer who were treated with adjuvant standard field as opposed to small pelvic field radiotherapy (RT). Study design: A retrospective observational study of patients with stage IB cervical cancer treated with radical surgery between 1984 and 2010 at Groote Schuur Hospital, Cape Town, South Africa. Two different pelvic radiation field sizes were used for adjuvant post-operative RT in node-negative patients during this period: standard whole pelvic fields (WPF), or with reduced-size, "small pelvic field" (SPF) RT since 1991. These two methods reflect changes in protocol over the period of this review. Cisplatin given concurrently with radiation has been used since 1999. Cancer control and grade 3 and 4 toxicities were compared between the two groups. The aim of this study was primarily to examine whether adjuvant SPF RT is a safe approach. A literature review was conducted on the subject of post-operative adjuvant RT, especially in node-negative patients; one aim was to discover how widely the SPF approach is used throughout the world. There was no indication in the literature that this approach has been used elsewhere in South Africa. Results: The SPF technique was first advocated by Prof Neville Hacker in Australia in 1991. The first publication by his group on SPF was in 1999, followed by several subsequent retrospective reports from Asian centers. In the current audit study, 31 patients were found in the WPF group, and 56 in the SPF group. The overall 5-year survival rate was 85%. No significant differences in survival rates were found between the WPF and SPF groups (log rank p=0.67) It was found that relapse patterns did not differ between the two groups and the same applied to the crude grade 3-4 treatment morbidity rates, although two patients in the WPF group (6%) died from their complications. Conclusions: The expected benefit of the SPF approach, which targets the central pelvic tumour bed, is a reduction in small bowel morbidity and lymphoedema. It is not possible to conclude from this study whether the SPF technique is unsafe by increasing out-of-field pelvic relapses, or whether it truly reduces complications. The literature review reveals that most studies of SPF involved relatively few patients and events were infrequent, whether recurrences or morbidity. A randomized controlled trial could theoretically settle this issue but it seems unlikely ever to be performed as a large sample size would be required. Intermittent single institution, or multi-institutional pooled comparisons, with historical WPF controls seem to be the best option.
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    A retrospective review: The outcomes of patients with anal carcinoma receiving treatment at Groote Schuur Hospital
    (2017) Dalmeyer, Lisa; Hunter, A; Robertson, Barbara
    Objectives: The objective of this study was to compare the outcome of two cohorts of patients with anal squamous carcinoma treated with split course chemoradiation as opposed to continuous chemoradiation at Groote Schuur Hospital. Demographics including age at diagnosis, gender and HIV status were reviewed. The stage at diagnosis, the acute treatment toxicities and all surgical procedures were noted. The outcomes included complete response rate, local control rate, loco-regional failure free survival, colostomy-free survival and overall survival. Design and Methods: The data was obtained from patient records of all patients with histologically confirmed anal squamous cell carcinoma seen and registered at the Department of Radiation Oncology at Groote Schuur Hospital. Patients included were those treated with radical intent that presented between the years of 2008 and 2012. This data was then compared with a similar study performed between 2000-2 004-. Results: A total of 72 patients diagnosed with anal squamous carcinoma were seen at Groote Schuur Hospital in the 5-year period, of which 4-0 patients fitted the criteria for this study. The median age was 53 years, with a slight male preponderance (55%) and 27.5% tested HIV positive. A total of 68% of patients had T3 and T4- disease, with 4-2.5% node positive disease. The complete response rate was 60%, the local control rate was 52.5% and the loco-regional failure free survival at 5 years was 56%. The colostomy-free survival was I-"4-% and the 5-year overall survival was 4-0.67%. Haematological, gastrointestinal and skin toxicities were reviewed and the most common acute side effect experienced was grade 2[32.5%] and grade 3[4-15%] skin toxicity. Conclusion: The patient characteristics and treatment toxicities are in keeping with previous study findings. However, complete response rate and overall survival were less than expected. Although there was no statistically significant difference in overall survival between the two cohorts of patients, there was a definite trend to inferior treatment outcomes of those patients treated with continuous chemoradiation. We propose radiation dose escalation for future treatment of patients presenting with anal carcinoma at Groote Schuur Hospital.
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    A retrospective review: long-term outcomes and predictors affecting long-term outcomes in osteosarcoma patients in the Groote Schuur Hospital patient population
    (2016) Hart, Heide; Parkes, Jeannette
    Background: Predictive factors for long-term outcomes in osteosarcoma patients are still controversial. There is no literature available regarding these factors in a patient population in a developing country. Objectives: To determine the outcome of treatment of osteosarcoma patients treated at Groote Schuur Hospital from 1990-2012 in terms of local control (LRC), disease free survival (DFS) and overall survival (OS) and to determine the value of suggested predictive factors in this population. Patients and methods: Retrospective review of all patients diagnosed and treated with osteosarcoma at Groote Schuur Hospital between 1990 and 2012, considering OS, DFS and LC. This review assesses the significance of suggested predictive factors from other studies, namely, HIV status, age at diagnosis, site of primary disease, type of chemotherapy used, response to chemotherapy and type of surgery in terms of OS, DFS and LC. Results: Forty-three patients with histologically confirmed osteosarcoma were treated at Groote Schuur Hospital between 1990 and 2012. Median 5 year OS was 57.8%. On univariate analysis, the site of disease was the only statistically significant predictive factor for prognosis. Conclusion: On univariate analysis, patients with axial disease have a worse predicted prognosis than those with primary disease in their extremities. The long-term outcome in our local clinical setting correlates favourably with the available international data. Due to the limited number of patients in the review, further research into HIV status, age, type of chemotherapy, type of surgery and their predictive value for prognosis in our patients with osteosarcoma is warranted.
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    Retrospective study of patients treated for Plasmablastic Lymphoma at Groote Schuur Hospital between 2004 and 2009
    (2014) Chiyapo, Sebathu Phillip; Mohamed, Zainab
    Includes abstract. Includes bibliographical references.
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    A retrospective study of patients with Stage IB2 cervical cancer treated at Groote Schuur Hospital 1993-2008
    (2013) Alleyne-Mike, Kellie; van Wijk, Leon; Hunter, Alistair
    Includes abstract. Includes bibliographical references.
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    Treatment outcomes of Epstein-Barr virus associated nasopharyngeal carcinoma with three-dimensional conformal radiotherapy: A retrospective review
    (2022) Viranna, Santhuri; Dalvie, Sameera
    Background: Data on treatment outcomes of Epstein-Barr virus (EBV) associated nasopharyngeal carcinoma (NPC) largely comes from endemic regions. There is limited literature available regarding the epidemiology and treatment outcomes of EBV associated NPC in South Africa. Aim: The primary aim of the study was to determine overall survival (OS) of patients with EBV associated NPC treated over an 11-year period. Setting: Groote Schuur Hospital, between January 2003 and December 2013. Methods: This is a retrospective observational study. Medical records of all patients with histologically confirmed NPC were reviewed. EBV staining was requested on all available archived specimens. All radical patients were treated with three-dimensional conformal radiotherapy (3DCRT). This review assesses the prevalence of EBV associated NPC, OS, disease-free survival (DFS), loco-regional control (LRC), and impact of treatment interruptions on OS. Results: The study population comprised 53 patients. Non-keratinizing carcinoma was the primary histological subtype (86.8%). 25 patients (47.2%) had histologically confirmed EBV positive NPC. The 2-and 5-year OS of radically treated EBV positive patients were significantly higher than EBV negative patients, 84% versus 34% and 45% vs 17% respectively (p=0.002). Two-year DFS was 55% vs 43% (p=0.38) and 2-year LCR were 76.2% vs 46.2% (p=0.13) for EBV positive and EBV negative patients respectively. The mean OS of patients with treatment interruptions was lower compared to those without interruptions (1249 days vs 1440 days). Conclusion: Treatment of EBV associated NPC is associated with superior OS, with a nonsignificant trend for improved DFS and LRC, compared to EBV negative tumours.
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    The types and treatment outcomes of germ cell tumours of the ovary seen at Groote Schuur Hospital, Cape Town, between 1994-2008 : a retrospective survey
    (2012) Mohammed, Khadiga Elfadil Ahmed; Wijk, Leon Van
    Includes abstract. Includes bibliographical references.